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General NPI Number Information
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NPI Number | 1679678171
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Entity Type | Organization
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Legal Business Name | SOUTH MAIN CHIROPRACTIC OF LEXINGTON, PLLC
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Dates
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Enumeration Date | 09/13/2006
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Last Update Date | 09/25/2012
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Provider Practice Location Address
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Address Line | 813 S MAIN ST
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City | LEXINGTON
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State | NC
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Zip | 27292-3150
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Country | US
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Telephone | 336-243-8000
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Fax | 336-243-8001
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Provider Business Mailing Address
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Address Line | 813 S MAIN ST
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City | LEXINGTON
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State | NC
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Zip | 27292-3150
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Country | US
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Telephone | 336-243-8000
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Fax | 336-243-8001
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Authorized Official
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Title or Position | MEMBER/ MANAGER
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Name | DR. PHILIP A. MAHAN
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Credential | DC
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Telephone | 336-243-8000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 2779
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License Number State | NC
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